Many patients want to avoid “medicines.” Yet symptoms of an enlarged prostate (waking at night to urinate, weak stream, dribbling) can be a real nuisance. Just because a product is a natural herb that is available without a prescription does not mean that it is completely safe or effective. There are two natural products that we know of that people use for enlarged prostate – saw palmetto and pygeum. There has been plenty of controversy about the effectiveness of saw palmetto, but the bulk of evidence shows no treatment effect. We therefore don’t routinely recommend this to our patients. There is even less compelling data to support the use of pygeum. There are also behavior options, including decreased evening fluids, decreased caffeine and alcohol and so-called “double-voiding,” which means going to the bathroom twice to try to empty your bladder more fully. There are also surgeries to reduce the size of your prostate, but most people would proceed to that only if medicine were not working.

The latest research says that it really does not matter. A recent systematic review of five studies found that stretching did not reduce soreness or injuries. another systematic review showed that warming up did not reduce injuries. We are not sure we believe this. There may be a couple of things going on here. With behaviors like warming up, cooling off and stretching, bodies just do what they do, and randomizing people can only minimize or maximize behaviors but not eliminate them. We think that in most sports, people warm up whether or not they identify the warm-up. The first few minutes of a run or a tennis match is always a little slower. The other thing is that not all stretching is alike. The latest we hear from coaches and personal trainers, as well as some physical therapists, is that stretching a “cold” muscle with a fixed or static stretch means you need to hold a position for 45 to 60 seconds. Dynamic stretches (stretching while moving) can be done more efficiently on cold muscles. Lastly, not all sports are alike. Jogging allows a slow warm-up period, while tennis is full-on impact with every move. So the study of joggers may not be suited to tennis players. We don’t know if any of this matters or when stretching is best. We like to stretch briefly before activity, warm up for a few minutes and stretch when done.